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Clinical Toxicology

Vidhya Kumar, Danny Issa, George Smallfield, Doumit Bouhaidar
BACKGROUND: The use of performance-enhancing drugs has increased dramatically in the last decade with high prevalence reported among the young athlete population. Many of these drugs contain anabolic steroids and may carry potential significant side effects and health risks. We report a case of anabolic steroid-induced acute pancreatitis (AP) that recurred after the reuse of the same drug by the patient, confirming the causative relationship. CASE REPORT: A 24 year-old male presented with severe epigastric pain...
August 12, 2018: Clinical Toxicology
Fredrik Hessulf
No abstract text is available yet for this article.
August 10, 2018: Clinical Toxicology
Anandhi D, Vinay R Pandit, Tamilarasu Kadhiravan, Soundaravally R, K N J Prakash Raju
BACKGROUND: Consumption of yellow oleander (Cascabela thevetia) is a popular method of intentional self-harm in South India. OBJECTIVES: The objectives of this study were to identify the cardiac arrhythmias and electrolyte abnormalities in yellow oleander poisoning and to identify the association between electrolyte abnormalities, cardiac glycoside concentrations at admission and the severity of cardiotoxicity. This study was also designed to identify clinical and biochemical parameters at presentation which predict serious arrhythmias and determinants of mortality...
August 3, 2018: Clinical Toxicology
Michael J Moss, Robert G Hendrickson
BACKGROUND: Amanita muscaria (AM) and A. pantherina (AP) contain ibotenic acid and muscimol and may cause both excitatory and sedating symptoms. Gastrointestinal (GI) symptoms are not classically described but have been reported. There are relatively few reported cases of poisoning with these mushrooms in North America. METHODS: This is a retrospective review of ingestions of ibotenic acid and muscimol containing mushrooms reported to a United States regional poison center from 2002-2016...
August 3, 2018: Clinical Toxicology
Keerat Grewal, Sarah Luckett-Gatopoulos, Madeline Renny, Mary Ann Howland, Mark K Su
No abstract text is available yet for this article.
August 1, 2018: Clinical Toxicology
Nicholas E Webb, David M Wood, Shaun L Greene, Laura J Hunter, John R H Archer, Alison M Dines, Paul I Dargan
OBJECTIVES: In May 2016, the Psychoactive Substances Act (PSA) came into effect in UK making it an offence to produce or supply new psychoactive substances (NPS). The aim of this study was to determine whether this was associated with a change in Emergency Department (ED) presentations with acute NPS toxicity. METHOD: ED presentations to our inner-city hospital in London, UK, with acute NPS toxicity in the 12 months before and after the PSA introduction [June 2015-May 2016 (2015/2016) and June 2016-May 2017 (2016/2017)] were obtained from our database...
August 1, 2018: Clinical Toxicology
Michael Eddleston, Thomas Lamb, Miran Brvar
No abstract text is available yet for this article.
July 25, 2018: Clinical Toxicology
Felicia Wong, Christopher J Edwards, Daniel H Jarrell, Asad E Patanwala
INTRODUCTION: The initial dose of naloxone administered to patients who present to the emergency department (ED) with opioid overdose is highly variable. The objective of this study was to determine if the initial dose of intravenous (IV) naloxone given to these patients was associated with the time to recurrence of opioid toxicity. METHODS: This was a multicenter retrospective cohort study, conducted at two academic EDs in the United States. Consecutive adults who had a positive response to naloxone for opioid overdose in the ED were included...
July 23, 2018: Clinical Toxicology
Blair L Bigham, Alex Harding, Lewis R Goldfrank
No abstract text is available yet for this article.
July 13, 2018: Clinical Toxicology
Johanna Nordmark Grass, Johan Ahlner, Fredrik C Kugelberg, Johanna Steinwall, Pär Forsman, Erik Lindeman
No abstract text is available yet for this article.
July 13, 2018: Clinical Toxicology
Amelia M Kasper, Alison D Ridpath, Roy R Gerona, Robert Cox, Robert Galli, Patrick B Kyle, Christina Parker, Justin K Arnold, Kevin Chatham-Stephens, Melissa A Morrison, Olaniyi Olayinka, Nykiconia Preacely, Stephanie M Kieszak, Colleen Martin, Joshua G Schier, Amy Wolkin, Paul Byers, Thomas Dobbs
STUDY OBJECTIVES: In April 2015, a multistate outbreak of illness linked to synthetic cannabinoid (SC) use was unprecedented in magnitude and severity. We identified Mississippi cases in near-real time, collected information on cases to characterize the outbreak, and identified the causative SC. METHODS: A case was defined as any patient of a Mississippi healthcare facility who was suspected of SC use and presenting with ≥2 of the following symptoms: sweating, severe agitation, or psychosis during April 2-May 3, 2015...
July 10, 2018: Clinical Toxicology
Yaron Finkelstein, Erin M Macdonald, Ping Li, Muhammad M Mamdani, Tara Gomes, David N Juurlink
BACKGROUND: Anti-depressants are among the most widely-prescribed medications. It is unknown whether the risk of seizure during therapeutic use differs by drug. We ranked the seizure risk of popular anti-depressants. METHODS: We conducted a population-based case-control study between April 2002 and March 2015 in Ontario, Canada. Cases were Ontario residents aged ≥65 years hospitalized for a first-ever seizure within 60 d of filling a prescription for one of nine second-generation anti-depressants, each dispensed more than 1 million times (range: 1,196,810 [fluvoxamine] to 19,849,930 [citalopram]) during the study period...
July 10, 2018: Clinical Toxicology
R Achterbergh, L A Lammers, L Kuijsten, H J Klümpen, R A A Mathôt, J A Romijn
INTRODUCTION: Fasting, as well as a high-fat diet, might increase the risk on acetaminophen-induced toxicity after an acute overdose. Therefore, it has been suggested to lower the threshold for acetylcysteine treatment to prevent liver injury in case of fasting. This study aims to investigate the effects of 36 hours of fasting and three days of a hypercaloric high-fat diet on acetaminophen measurement and exposure. METHODS: Nine healthy male subjects were enrolled in a randomized crossover intervention study...
July 5, 2018: Clinical Toxicology
Katherine Z Isoardi, Keith Harris, Kate E Carmichael, Goce Dimeski, Betty S H Chan, Colin B Page
OBJECTIVE: Acute methotrexate overdose rarely causes systemic toxicity due to saturable absorption and rapid renal elimination. We present a case of methotrexate toxicity following acute overdose. CASE REPORT: A 56-year-old female presented soon after an overdose of 1250 mg of methotrexate, zopiclone and tramadol. The methotrexate was initially under-reported (500 mg) and folinic acid was not provided. Despite normal renal function, the patient developed toxicity...
July 5, 2018: Clinical Toxicology
Sean P Boley, Travis D Olives, Stacey A Bangh, Samuel Fahrner, Jon B Cole
CONTEXT: Poison centers (PCs) frequently manage patients with antimuscarinic delirium. However, controversy surrounds the antidotal use of physostigmine for its treatment. The aim of this study was to prospectively investigate physostigmine versus non-antidote therapy for the management of antimuscarinic delirium in a single regional PC. METHODS: This was a prospective observational analysis of patients diagnosed with antimuscarinic delirium and treated in consultation with a regional PC...
June 29, 2018: Clinical Toxicology
Derek Rusin, David Nickeson, Aaron W Tustin
No abstract text is available yet for this article.
June 26, 2018: Clinical Toxicology
Tharwat El Zahran, Brent W Morgan, Stephanie Hon, Lloyd Herrington, Robert J Geller
CONTEXT: Trazodone is an atypical antidepressant with no established safety in children. Previous case reports showed no complications at doses 50-500 mg in children. Our study objective is to characterize the clinical effects, dose-related toxicity, and establish triage dose for acute trazodone ingestions in children ≤6 years of age. METHODS: Cases with acute trazodone ingestions in children ≤6 years of age between 2000 and 2015 were retrospectively reviewed...
June 22, 2018: Clinical Toxicology
Elisabeth Wigenstam, Linda Elfsmark, Lina Ågren, Christine Akfur, Anders Bucht, Sofia Jonasson
CONTEXT: Inhalation of sulfur dioxide (SO2 ) affects the lungs and exposure to high concentrations can be lethal. The early pulmonary response after inhaled SO2 involves tissue injury, acute neutrophilic lung inflammation and airway hyperresponsiveness (AHR). In rats, long-term pulmonary fibrosis is evident 14 days post-exposure as indicated by analysis of collagen deposition in lung tissue. Early treatment with a single dose of dexamethasone (DEX,10 mg/kg) significantly attenuates the acute inflammatory response in airways...
June 20, 2018: Clinical Toxicology
(no author information available yet)
No abstract text is available yet for this article.
June 14, 2018: Clinical Toxicology
Marcee E Wilder, Lynne D Richardson, Robert S Hoffman, Gary Winkel, Alex F Manini
OBJECTIVES: Racial and ethnic disparities in the United States continue to exist in many disciplines of medicine, extending to care in the Emergency Department (ED). We sought to examine the relationship between patient race/ethnicity and use of either antidotal therapy or gastrointestinal decontamination for individuals presenting to the ED for acute drug overdose. METHODS: We completed a secondary analysis of a prospective cohort of patients with suspected acute overdose presenting to two urban tertiary care hospitals between 2009 and 2014...
June 12, 2018: Clinical Toxicology
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